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76 Cards in this Set

  • Front
  • Back
hyperthyroidism and hypolglycemic reactions cause symptoms often indistinguishable from
hypothyroidism can make a patient look and feel
panic disorder
sudden severe anxiety, smothering sensation, chest pain with complete recovery
fear of going out in public
the pulse rate in panic disorder
usually be normal at rest < 80bpm
epinephrine and norepinephrine
are hormones that act at distant sites in the body and also neurotransmitters that work at synapses in the brain. They are excitatory at all locations.
incidence of panic disorders
non-drug induced auditory hallucination, delusions, tangential thinking

psychiatric consult is always indicated, but the degree of urgency depends upon the practitioner's best estimate of the patient's impairment and the degree of danger they represent to themselves or others.

the meds have significant side effects and many patients do not take them reliably because they don't think they need them or they don't like the side effects
positive symptoms of schizophrenia
delusions of grandeur, persecution or control
rapid and unpredictable shifts in mood
hypersensitivity to stimuli of any sort
unstable and inappropriate laughter
negative symptoms or deficits of schizophrenia
lack of enthusiasm
difficulty in speech
decline in overall function
social withdrawal and disruptions
deterioration of personal care and hygiene
dependency on others, low self-esteem
risk factors of schizophrenia
older father
family history
prenatal maternal bereavement, famine, and malnutrition
low socioeconomic status
alcohol and street drug use

** No food Allergy**
co-morbidities with schizophrenia
depression, sadness, anxiety, pessimism
left handedness
schizophrenia generally requires:
combines interventions including social work, behavioral, psychology, and medication.
Major depression
patient who feels pessimistic, hopeless, and helpless
referral options for major depression
options will depend upon level of risk for suicide and the patient's ability to pay for services, transportation and other factors. Psychological emergency services should immediately be contacted for patients with plans to commit suicide and who refuse to sign a "no self-harm" contract
typical history and symptoms of major depression
depressed patients may instead complain of decreased interest in people and activities that were formerly interesting, a sense that life is not rewarding or, in more severe cases, hoplessness and helplessness. Often, if asked if they see "light at the end of the tunnel," they will say, "No"
Physical finding for major depression
depressed patients may look down often, sigh, avoid eye contact, and look like the "weight of the world" is on their shoulders
Risk factors of major depression
sedentary lifestyle
social isolation
women have higher incidence rates than men
Irregular sleep and work habits, particularly, swing or night shift work
lifestyle with inadequate daylight exposure or sudden move from equatorial to polar latitudes
co-morbidities of major depression
alcohol and drug abuse
postpartum state
traumatic brain injuries or surgery
diet low in omega 3 fatty acids and low vitamin D3 levels
other important considerations of major depression
half of all suicide victims suffer from major depression and suicide occurs in 25% of people with chronic depression
Manic phase of bipolar disorder
depression followed by an episode of hyper-excitation and euphoria

one illness in the family of illnesses known as "bipolar spectrum disorders" (BSD) defined by the presence of cycling, recurrent episodes of abnormally elevated mood interspersed with episodes of depressive mood
history and symptoms of bipolar disorder
bipolar patients cyclically experience abnormally elevated (manic or hypomanic) episodes followed by abnormally depressed episodes that are severe enough to interfere with their normal functioning
characterized by feelings of irritability, euphoria or excessive expansiveness

patients in mania may be intrusive, aggressive, and intolerant of others
incidence of bipolar disorder
the median age of onset for bipolar disorder is 25 years of age
Drug abuse (partial loss of control over drug use) or addiction (loss of control over drug use)
personality change, social withdrawal, unstable relationships, evasiveness and decreased academic performance in an adolescent or adult
number of Americans with fatty livers
1/3 or 1 out of 3
history and symptoms of drug abuse
in adults, the personality change and problems functioning are generally noticed by employers and coworkers. Hiding of substances, evasion and disharmony is common among spouses.
physical exam finding of drug abuse
adolescents and young adults can express paranoid thinking, ideas of victimhood, unrealistic fantasies, grandiosity, and melodramatic language.
Young adults who smoked marijuana regularly:
starting around 15 years of age, were twice as likely to develop psychosis and four times as likely to have delusional thinking in a "dose response" relationship than those who did not.
Marijuana can produce:
Antimotivational syndrome=
spend significantly less time in productive activities and more time in recreating
Drug addiction does or does not change main structure of brain?
Addiction permanently affects the structure and function of the brain. Can cause changes in the dopaminergic mesolimbic system that results in loss of control over the use of the addictive substance. Changes are mediated by a number of neurotransmitters.
When patients use opiates, the effect on the neuron is to dampen down neuronal transmission + pain relief. Habitual usage cause glial cells to:
respond by producing inflammatory products that they send to the neuron in an effort to wake it up.
When a person stops taking the opiates, the normal neuronal activity picks up again AND the neuron is hyper-excited because the glial cells continue their stimulatory efforts, sometimes for months
Palpitations that are absent with exercise and present at rest are almost always:
Benign palpitations
Palpitations that occur reliably with exercise and go away with rest=
RED FLAG for some type of heart disease
Chest pain that occurs reliably with exercise and goes away with rest = red flag for
coronary artery disease
Tachycardia is the most reliable sign of
hyperthyroidism, the rate >100 bpm
Tachycardia with fever are the most reliable signs of:
thyroid storms

Thyroid storms can lead to heart failure and death
Rate of symptoms of hyperthyroidism:
Increase so gradually that patients may have mild to moderate symptoms for weeks or even months before suspecting a problem
Hyperthyroid Patients often complain of:

Family members often complain of:
Trembling hands and a pounding or irregular heartbeat (palpitations)

mood swings and irritability (emotional lability). Hypervigilance (from fast thinking) is usually interpreted anxiety.
Other signs of hyperthyroidism:
Patients feel hotter than others
Heat intolerance
Warm, moist skin and easy perspiration
mild diarrhea
light or skipped menses
often fatigued at the end of the day
trouble falling asleep
weight loss despite eating more

Severe hyperthyroidism: short of breath, chest pains, muscle weakness
Hyperthyroidism in the elderly
Often, typical symptoms of hyperthyroidism may be missing

May complain of weight loss, fatigue, depression and/or anxiety
More about Thyroid storm
same symptoms as in hyperthyroidism, but heightened and with addition of fever and tremor.
Temp may be above 105.5 degrees and accompanied by nausea, vomiting, diarrhea, dehydration, delirium, and eventually coma.
Apathetic Storm in elderly
characterized by extreme weakness
emotional apathy
confusion rather than delirium and agitation
fever may be minimal

(appears as hypothyroid, but is hyperthyroid)
Death rate from thyroid storms
Prevalence of hyperthyroidism and thyroid storm:
More common in women than men
Risk factors for hyperthyroid storms
Infections, esp. lung pts w/hyperthyroidism
stopping medication (to suppress hyperthyroidism)
excessive dose of thyroid hormones
heart attacks
other autoimmune diseases
TIA/Transient ischemic attack:
Fifteen minute episode of unilateral tingling/numbness that resolves completely
Acute episode
temporary neurologic dysfunction
caused by ischemia (tissue threat w/out permanent damage)
due to: vascular occlusion w/symptoms lasting less than one hour
Consequence of TIA
20% of patients w/new TIA will later have a disabling or fatal stroke later

4-5% risk of stroke within 2 days of TIA
11% risk of stroke within 7 days following TIA
If a pt is having a TIA:
Immediately transport (or 911 transport) to ED
Urgent b/c it is impossible to say if person will recover or progress to a stroke

with cardiopulmonary instability, 911 should be called
with a resolved TIA;
same day, semi-urgent consultation with PCP or neurologist

May be sent to ED if no consultant can see them within the same day
Test for TIA

O = ORIENTATION to person, place and time

M = checking MEMORY function

I = checking INTELLIGENCE function

T = checking TALKING function

also: standard check on cranial nerves, sensation, muscle strength, reflexes, balance and special tests (in spinal cord injury section)

Check carotids and heart because carotid bruit may be present or heart arrhythmia or murmurs may indicate valvular damage
Per Drew...and TIA
If someone has a TIA, within 2 - 7 days they could get another one and die
Stabilization of TIA condition:
If you see a pt during the symptoms of TIA, have them lay down quietly and refer for consultation or to the ED

If they are between neurological symptoms, advise them to take one baby aspirin per day until consult is accomplished. (prevention for possible strok)
Risk factors for TIAs:
cigarette smoking
physical inactivity
diet high in animal fat and salt (in salt sensitive pts)
Low HDL, high LDL, high TG, high homeocysteine levels, high C-reactive protein
too much alcohol intake
use of cocaine and other drugs
birth control pills should be avoided if obesity, diabetes or hbp exist
Multiple sclerosis
Slow onset of patchy numbness and weakness >1 body area

Most common of several autoimmune demyelinating disease in the brain and spinal cord
No cure for MS, but
can be managed and early referral is required because MS is a slow progressing disease.
Left untreated, can result in disability or death
Symptoms of MS
-paresthesias and/or areas of patchy numbness in one or more extremities, trunk or face
-weakness or clumsiness of a leg or hand
-numbness is patchy, often skipping over dermatomes (can come and go within few days to a few weeks)
-double vision
-skin tingling and skeletal muscle weakness
-feeling of slight stiffness of a limb
-minor gait disturbances
-bladder fxn difficulty
-skeletal muscle weakness
-muscle spasticity in some areas, flaccidity in others
warm weather or hot bath may exacerbate sx
-in some cases, mild cognitive impairment
-poor judgement
-emotion liability or depression
Risk factors
Family history of MS

cooler climates (highest incidences in northern Europe, northern US, southern Australia and New Zealand)
MS Onset
usually between 20 - 40 years old
More common in women
Tests for MS
* Romberg's signs (feet together, eyes closed)
* Babinski reflex (bottom of the foot test)
* gait and coordination test...heel to heel, toe to toe, repeatedly and rapidly touching finger to nose

* standard vision test--high incidence of optic neuritis
*vibration and position sense of toes
timing abnormalities of the pulse
how the pulse feels
Halter Monitor
24 hour monitoring of the heartbeat
can reveal normal heart rhythm when a patient reports significant palpitations
Atrial Fibrillation
fluttering of the heart chamber that contains the natural pacemaker of the heart, the SA node.

Irregularly irregular pulse with rate >100 bpm
referral options for A-fib
911 should be contacted for patients with:

severe shortness of breath
chest pain
more rapid heartbeat (> 120 for example)

this red flag is an example of an irregularly irregular pulse, a pulse that is completely unpredictable and has no discernible pattern.
History and symptoms of A-fib
many patients have no symptoms

the most common symptom in people with intermittent A-fib is palpitations

**NO stimulating herbs **
physical finding of A-fib
stable patients may exhibit no signs except irregularly irregular pulse
incidence and prevalence of A-fib
most common arrhythmia, affecting about 1% of the population, mostly older than 50

1.5% aged 50-59

30% aged 80-89
risk factors of A-fib
previous heart disease like CAD
valvular heart disease
sinus node disease
high blood pressure, especially uncontrolled
blood thinners

**make sure they have enough Mg **
red flag for A-fib
the atria may contract at a rate of 400-600 per minute
Important considerations in A-fib
most people with chronic or recurrent A-fib take warfarin (Coumadin) to lower the risk of stroke
What is a holter monitor used for?
a portable device for continuously monitoring various electrical activity of the cardiovascular system for at least 24 hours (often for two weeks at a time).
have a social worker
behavior psychologist
Stable angina =
chest pain only w/ extreme physical exertion-can refer same day PCP.
UNStable angina =
chest pain w/ minimal exertion (but no current pain = ref to ER. Pt should not drive.